USE OF THE OMENTUM IN THE MANAGEMENT OF STERNAL WOUND-INFECTION AFTERCARDIAC TRANSPLANTATION

Seven patients with deep sternal wound infection after orthotopic card iac transplantation were treated at the Medical College of Virginia-Mc Guire Veterans Administration Hospitals over a 3-year period. Six pati ents had mediastinitis with pericardial abscess, and one patient had o nly sternal osteomyelitis. All patients underwent prompt sternal debri dement. In the six patients with mediastinitis, the transplanted heart was surrounded by a large dead space after debridement. This space ap peared to result from a size mismatch between the remaining enlarged p ericardial sac and the new normal-sized transplanted heart. Wound clos ure was done at the time of debridement in all patients except one who was closed 3 days later. A pedicled omental flap based on the right g astroepiploic artery was used in five of the six patients. with medias tinitis, and these five patients healed their wounds and resolved thei r infection. Three of these patients are alive and well and tire died of later complications other than sternal infection. The patient with only sternal osteomyelitis healed uneventfully. When mediastinitis and intrapericardial infection is present after cardiac transplantation, the omentum appears to provide adequate bulk for obliteration of the l arge dead space that remains after debridement. This surgery, combined with antibiotic therapy and temporary reduction of immunosuppression, can treat sternal wound infection successfully after cardiac transpla ntation. Mortality from other complications can occur, however, and no t all patients survive.